Health insurance is mandatory in Germany, and for expats it is one of the most confusing parts of relocating. You can choose between public insurance (GKV) and private insurance (PKV, Private Krankenversicherung), but not everyone is allowed to choose. And a decision made in your first year can affect you for decades.
This guide explains who can go private, how PKV works, which insurers are popular with expats, and the mistakes to avoid.
Public vs Private Health Insurance in Germany
| Feature | Public (GKV) | Private (PKV) |
|---|---|---|
| Premium based on | Percentage of your income | Age, health, and chosen coverage |
| Family members | Spouse and children often covered free | Each person needs their own policy |
| Coverage | Standardized by law | Depends on your tariff |
| Waiting times | Can be longer for specialists | Often shorter |
| Premiums over time | Change with income | Tend to rise with age and medical costs |
| Health check at signup | No | Yes, health questions are required |
Who Can Choose Private Health Insurance?
Not every expat can go private. You generally qualify if you are:
- An employee earning above the income threshold (Versicherungspflichtgrenze). This is set annually, so check the current figure.
- Self-employed or a freelancer (Freiberufler).
- A civil servant (Beamter).
- A student, in some cases, by opting out of the public system.
- An employee who is exempt from public insurance for other reasons.
If you are an employee below the threshold, public insurance is usually mandatory.
Why Expats Choose PKV
- Faster specialist appointments in many cases
- Better coverage options, such as private or single hospital rooms and chief physician treatment
- English-speaking service at some insurers
- Lower premiums when young and healthy, especially for single people with high incomes
- Flexible tariffs that can be customized
Important Downsides to Consider
PKV is not always the better choice. Think carefully about:
- Premiums rise with age. Cheap in your 30s does not mean cheap in your 60s.
- Family costs. Spouses and children need separate policies, which can get expensive.
- Health questions. Pre-existing conditions can lead to surcharges, exclusions, or rejection.
- Difficult to switch back. Returning to public insurance is limited, especially after age 55.
- Income drops. If your income falls below the threshold, you may become unable to keep your policy and face difficulty.
- Long-term commitment. Private insurance is designed to be long term.
Popular Private Health Insurers for Expats
Availability, English support and tariffs vary, so compare current offers before deciding.
Ottonova
A digital-first insurer with an English-friendly app. Popular with younger expats and professionals who want an easy, modern experience.
Best for: Tech-savvy, young, healthy expats.
Allianz Private Krankenversicherung
One of Germany’s biggest insurance groups, offering a wide range of tariffs and strong financial stability.
Best for: Expats who want a large, established provider.
DKV
One of the largest specialists in private health insurance in Germany, with a broad tariff selection.
Best for: Those who want a health-focused insurer with flexible options.
HanseMerkur
Known for having tariffs and services aimed at expats and international customers.
Best for: Expats who need international-friendly options.
Barmenia
Offers a wide selection of tariffs, including options for self-employed people and families.
Best for: Freelancers and families comparing tariffs.
Debeka
A very large insurer, particularly strong with civil servants and public sector employees.
Best for: Beamte and public sector employees.
AXA
An international insurer with a presence in Germany, useful if you value a global brand.
Best for: Expats who want an international provider.
Signal Iduna and Continentale
Both offer solid German PKV products and are worth including in your comparison.
Best for: Expats comparing mainstream German insurers.
Note: This is not a ranking of guaranteed quality. Best fit depends on your age, health, job, and budget.
What Does PKV Typically Cover?
Depending on your tariff, coverage may include:
- Doctor visits and specialists
- Hospital stays (with options for private rooms)
- Dental care and dentures
- Prescription medication
- Preventive checkups
- Maternity and childbirth
- Vision aids (glasses, contact lenses) in some tariffs
- Alternative medicine (Heilpraktiker) in higher tariffs
- Psychotherapy (varies significantly by tariff, so check this)
Read the tariff details carefully, because “private” does not automatically mean “better.”
How Much Does PKV Cost for Expats?
Premiums depend on:
- Age at entry: Younger means cheaper to start
- Health status and history
- Chosen coverage level
- Deductible (Selbstbeteiligung): A higher deductible lowers your monthly cost
- Job status: Employees usually receive an employer contribution; freelancers pay everything themselves
Get several personalized quotes, since online estimates often do not include health surcharges.
Expat Health Insurance vs Full PKV
Some expats are confused about the difference.
- Full PKV (Vollversicherung): Complete German-compliant health insurance for long-term residents.
- Expat or incoming insurance: Short-term coverage for visitors, students or people newly arrived. It is often cheaper but usually less comprehensive and may not satisfy the legal requirement for long-term residents.
For visas and long-term stays, check which type the authorities accept.
Step-by-Step: How to Get Private Health Insurance in Germany
- Check your eligibility. Are you above the threshold, self-employed, or otherwise eligible?
- Compare public and private options. Consider your family plans and long-term income.
- Decide on the coverage you need. Hospital room type, dental, and deductible.
- Collect your health history. Insurers ask detailed questions, and answering honestly is essential.
- Get quotes from multiple insurers. Ideally through an independent broker.
- Submit your application. The insurer reviews your health information.
- Receive your offer and policy. Check exclusions and surcharges carefully.
- Provide proof of insurance to your employer, the immigration office, or the authorities.
Tips Before You Sign
- Answer health questions truthfully. Misstatements can cause the insurer to cancel or refuse claims later.
- Do not choose based only on the lowest price. Cheap tariffs may have limited coverage.
- Plan for age. Ask how premiums have historically developed.
- Consider a higher deductible carefully. It saves money monthly but can hurt in a bad year.
- Ask about English-language support, especially for claims and documents.
- Use an independent broker who compares many insurers. Check whether they are paid by commission.
- Think about your family plans before deciding.
Frequently Asked Questions
Can any expat get private health insurance in Germany?
No. Employees below the income threshold generally must use public insurance. Freelancers, self-employed people, and high earners can usually choose.
Is private health insurance cheaper than public for expats?
Often yes when you are young, healthy, and single. It can be more expensive for families, older people, or those with health issues.
Can I switch from private to public later?
Only in limited situations, and it becomes very hard after age 55.
Do I need German to buy private insurance?
Not necessarily. Many insurers and brokers offer English service, but policy documents are often in German.
Does private insurance cover my family?
Not automatically. Spouses and children usually need their own policies, though there are child tariffs.
Is short-term expat insurance enough for a residence permit?
Sometimes for initial stays, but not for long-term residents. Confirm with the immigration office.
Final Verdict
The best Private Krankenversicherung for expats in Germany depends on your job, age, health, income and family plans. Digital insurers like Ottonova suit young professionals, while Allianz, DKV, HanseMerkur and Barmenia offer broad tariffs that are worth comparing. Above all, make sure you are eligible, understand the long-term costs, and consider speaking to an independent adviser before making this decision.
Disclaimer: This article is for general information only and is not insurance, financial or legal advice. Rules, thresholds and premiums change. Confirm details with insurers or a qualified adviser.